摘要
目的 探讨股骨侧严重骨缺损（Paprosky ⅢA型）翻修中应用髓内打压植骨结合广泛多孔涂层长柄假体的临床疗效.方法 2006年3月～2010年9月,对38例（38髋）Paprosky ⅢA型股骨骨缺损患者行翻修重建,其中男24例,女14例,平均年龄62岁.翻修原因：骨溶解、无菌性松动29例,全髋关节置换术（THA）术后感染二期翻修6例,假体周围骨折3例（Vancouver B3型）.股骨侧干骺端骨缺损采用同种异体颗粒骨髓腔内打压植骨进行修复,股骨柄采用全涂层长柄假体（7～10英寸）.术后定期随访,髋关节功能评价采用Harris评分,影像学采用X线片及CT观察：假体柄有无松动下沉、股骨近端应力遮挡情况、植入的异体颗粒骨与宿主骨整合情况.结果 38例均获得随访,平均随访53.4个月（23～62个月）,Harris评分由术前平均42分（32～47分）,提高至末次随访时平均86分（69～95分）.无患者发生脱位、假体周围骨折.1例术后感染,行再次二期翻修;1例假体柄在术后6个月内下沉4.24 cm,再次翻修时选择更粗的假体柄,末次随访时假体柄稳定;其余所有患者假体柄均牢固固定.3例出现轻-中度应力遮挡.15例近端皮质骨密度及厚度有增加,厚度平均增加约1.8 mm（0.7～3.5 mm）,植入骨与宿主骨逐渐整合并增加了骨缺损区的骨质储备.结论严重骨缺损（Paprosky ⅢA型）的股骨翻修中,采用髓内颗粒骨打压植骨可以很好的修复股骨中上段骨缺损,重建股骨干骺端.依靠广泛多孔涂层长柄假体在远端的牢固压配固定,结合股骨干骺端髓内紧密打压植骨,使假体柄在股骨中上段及远端均能获得较好的初始稳定性,近期临床和影像学结果满意,远期疗效有待观察.
Objective To determine the efficiency and short medium clinical outcomes of intramedullary impacted cancellous allografts with extensively porous coated long stem for the stem revision with severe bone loss. Methods From March 2006 to September 2009, 38 patients （38 hips） underwent revision hip arthroplasty in femurs for severe bone defects （Paprosky ⅢA）. The reasons of revision included： osteolysis/ aseptic loosening in 29 cases, infection in six cases, periprosthetic fractures in three cases. The patients were followed up postoperatively to observe the clinical and radiological results and if there was stem subsidence, periprotheric fracture, infection and other complications. Results The mean follow up time was 53.4 months. Harris Scores improved from 42 points pre operation to 86 points at the final follow up. One case had infection after the revision and was treated by further two stage re revision. Another case had the stem subsidence of 4.24 cm within six months after the revision and underwent a re revision in the same way with a longer stem. Mild stress shielding occured in two cases and moderate stress shielding in one case. At the end of the follow up, no femoral stems loosening and failure was observed. The radiographic analysis showed all the revised stems were stable and the grafts incorporation were seen. The proximal cortical bone mineral density and the thickness of 15 cases had increased; the average thickness was 1.8 mm （0.7-3.5 mm）. Conclusions The intramedullary impacted cancellous allograft is an efficacious way to restore the bone stock, and the combination of the intramedullary impacted cancellous allograft with the extensively porous coated long stems in distal press fit fixation is a good method for the femoral revision with severe bone loss. The short medium clinical and radiographic outcomes are encouraging. Further follow up is needed to confirm the long term results.
出处
《中华关节外科杂志（电子版）》
CAS
2014年第1期36-40,共5页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
关节成形术
置换
髋
打压植骨
再手术
骨缺损
Arthroplasty,replacement,hip
Allografts
Reoperation
Bone defects
